Firefighters/EMS personnel are vital for public health safety, representing over two million individuals nationally. Because firefighters are required to respond to almost every domestic emergency, there is wide agreement that their health and readiness is of particular importance. Furthermore, a broad range of occupational exposures exist that negatively impact the health of firefighters. While the field of firefighter health has enjoyed growth over the past decade, the health of female firefighters remains largely unexamined. Similar occupational groups, such as the military, have developed focused programs to understand the unique work-related challenges to women's health; however, research in the fire service has remained relatively silent on the topic. This dearth of informatio likely contributes to the remarkably low rates of females recruited and retained by the fire service. While challenges such as harassment in the workplace have been identified as concerns for female firefighters, health concerns beyond emotional stress have received limited attention. Anecdotal evidence suggests that issues such as reproductive health, ill-fitting gear, and on-the-job injuries attributable to standard operating procedures and guidelines that do not accommodate differences in female characteristics are barriers to women serving as firefighters. The military, a similar population with regard to work task, environment, and a tradition of being primarily male, has been successful in making female health a priority through the development of a focused program of gender specific research. Despite significant cultural barriers, the armed forces have been successful in recruitment and retention of female personnel at a rate that far exceeds the US fire service. In this proposed project, we will use a multi-methods research design to examine health and safety issues among female firefighters. In addition, this study will identify factors which serve as barriers to recruitment and retention of women in the fire service. Unique strengths of this R21 developmental application include strong support from the largest national fire service organization focusing on women and an investigative team with a documented history of successful research on the health of firefighters. Research for this formative research will be conducted in three phases including: 1) focus groups with a national sample of female firefighters, and key informant interviews with male and female fire service opinion leaders; 2) key informant interviews with female firefighters who have chosen early retirement to determine barriers to retention among this population and 3) an epidemiological survey of a sample of female firefighters to determine current health status and health concerns across a number of domains. This innovative study is a critical step in addressing gender inequity of the US Fire Service and identifying areas of intervention and prevention for this understudied occupational group. PUBLIC HEALTH RELEVANCE: The US fire service serves as the front line of defense against any domestic emergency, often with negative consequences for the health of firefighters. While research on occupational risk factors in firefighters has received increased attention over the past decade, female firefighters' unique health concerns have largely been ignored and this dearth of knowledge likely contributes to the remarkably low number of female firefighters. By exploring barriers to health and wellness among female firefighters through accessing the perspectives of both firefighters and key fire service leadership, as well as conducting a national survey of health concerns, this study will be the first to address significant knowledge gaps about women who play a key role as first responders in ensuring public safety.